DOI: 10.1177/19160216261454991 ISSN: 1916-0216

Endoscopic Type I Tympanoplasty: Comparative Outcomes of Autograft, Allograft, and Xenograft

Yi-Chen Tsai, Chih-Yu Hu, Bang-Yan Zhang, Kuan-Ting Yeh, Kai-Chieh Chan
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Importance

To our knowledge, this represents the first adult-only, fully endoscopic, three-arm comparative cohort of autograft, allograft, and xenograft materials in type I tympanoplasty.

Objective

To compare graft-take, audiometric outcomes, operative time, and complications among perichondrium, MegaDerm, and Biodesign in adult endoscopic type I tympanoplasty.

Design:

Retrospective comparative cohort study.

Setting:

Tertiary referral center.

Participants:

Adults who underwent endoscopic type I tympanoplasty with perichondrium, MegaDerm or Biodesign between October 2021 and March 2025. Patients with revision surgery, concomitant otologic procedures, active middle-ear disease, profound sensorineural hearing loss, preoperative air-bone gap (ABG) ≥50 dB, or follow-up <3 months were excluded.

Intervention or Exposures

Endoscopic type I tympanoplasty using perichondrium (autograft), MegaDerm (allograft), or Biodesign (xenograft).

Main Outcome Measures:

Graft-take rate, hearing gain (air-conduction and ABG), operative time, and complications.

Results

Ninety-three ears were analyzed (perichondrium n = 33; MegaDerm n = 21; Biodesign n = 39). Three-month graft-take rates were similar, and final graft-take rates remained comparable across groups (3 months: 90.9%, 90.5%, 94.9%; P  = .6862; final: 84.8%, 85.7%, 84.6%; P  > .999). Air-conduction (AC) and ABG improved significantly within all groups. Between-group differences were not significant for AC gain (13.79 ± 9.84 vs 7.24 ± 12.46 vs 9.14 ± 10.01 dB; P  = .0804) or ABG gain (9.58 ± 10.46 vs 8.82 ± 10.37 vs 7.58 ± 8.46 dB; P  = .7757); the proportion achieving postoperative ABG ≤20 dB was similar ( P  = .475). Operative time was significantly longer for perichondrium (98.23 ± 32.35, 68.52 ± 20.84, and 74.88 ± 17.27; P  < .0001). Complications were infrequent (otomycosis, n = 3; myringitis, n = 1), and no facial palsy, intractable vertigo, profound sensorineural hearing loss(SNHL), or dysgeusia occurred.

Conclusion:

In adult endoscopic type I tympanoplasty, perichondrium, MegaDerm, and Biodesign demonstrated comparable short-term graft-take and audiometric outcomes, while commercially available grafts were associated with shorter operative time.

Relevance:

These findings support patient-centered graft selection balancing donor-site considerations, operative efficiency, and cost; prospective studies with standardized follow-up and patient-reported outcomes are warranted.

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